Injections and Implants for Back Pain Relief

Procedures and devices that deliver pain medications locally, not orally

Sometimes doctors use injections or implanted devices to deliver pain relief medication locally instead of using oral pain drugs. Some implanted devices don’t deliver medication, but instead use other techniques for pain relief.

Doctors may give several different types of injections for back pain. The best one for you, should you need one, will depend on your particular problem. These injections include:

• Epidural steroid injections. When inflammation within the spinal column causes nerve-root irritation and swelling, doctors sometimes administer a potent anti-inflammatory medication to reduce inflammation and ease pain. Steroids typically are injected directly into the epidural space – the area between the dura mater and the vertebrae – to deliver pain-relieving medication directly to the site of inflammation. Pain relief typically begins in less than a week and lasts anywhere from several days to a few months.

• Selective nerve-root block. When a nerve root is compressed or inflamed, it can cause pain in the back and leg. A selective nerve-root block is an injection of a steroid and/or numbing agent into the area of the nerve where it exits the spinal column between the vertebrae. Pain relief begins within a few days to a week and may last up to a few months.

• Facet joint block. If your doctor suspects the source of your pain is in the facet joints, where the vertebrae connect to one another, she may recommend a procedure called a facet joint block. In this procedure, a steroid and/or anesthetic medication is injected directly into the joint capsule. Pain relief may last several weeks or months.

• Facet neurotomy. A facet neurotomy is a procedure used in people for whom a facet joint block has suggested that a particular joint is a cause of back pain. This procedure uses a heated needle to burn and disable the nerve responsible for the pain. Although the nerve usually grows back, allowing pain to return, this can take several months to a year.

• Sacroiliac joint block. Sacroiliac joint blocks involve injecting an anesthetic or anti-inflammatory medication into the sacroiliac joint, which connects the sacrum (one of the sections of the spine, composed of five fused vertebrae) to the pelvis. These may be used to relieve low back pain that results from inflammation or damage within the sacroiliac joint.

Sometimes doctors use injections or implanted devices to deliver pain relief medication locally instead of using oral pain drugs. Some implanted devices don’t deliver medication, but instead use other techniques for pain relief.

Doctors may give several different types of injections for back pain. The best one for you, should you need one, will depend on your particular problem. These injections include:

• Epidural steroid injections. When inflammation within the spinal column causes nerve-root irritation and swelling, doctors sometimes administer a potent anti-inflammatory medication to reduce inflammation and ease pain. Steroids typically are injected directly into the epidural space – the area between the dura mater and the vertebrae – to deliver pain-relieving medication directly to the site of inflammation. Pain relief typically begins in less than a week and lasts anywhere from several days to a few months.

• Selective nerve-root block. When a nerve root is compressed or inflamed, it can cause pain in the back and leg. A selective nerve-root block is an injection of a steroid and/or numbing agent into the area of the nerve where it exits the spinal column between the vertebrae. Pain relief begins within a few days to a week and may last up to a few months.

• Facet joint block. If your doctor suspects the source of your pain is in the facet joints, where the vertebrae connect to one another, she may recommend a procedure called a facet joint block. In this procedure, a steroid and/or anesthetic medication is injected directly into the joint capsule. Pain relief may last several weeks or months.

• Facet neurotomy. A facet neurotomy is a procedure used in people for whom a facet joint block has suggested that a particular joint is a cause of back pain. This procedure uses a heated needle to burn and disable the nerve responsible for the pain. Although the nerve usually grows back, allowing pain to return, this can take several months to a year.

• Sacroiliac joint block. Sacroiliac joint blocks involve injecting an anesthetic or anti-inflammatory medication into the sacroiliac joint, which connects the sacrum (one of the sections of the spine, composed of five fused vertebrae) to the pelvis. These may be used to relieve low back pain that results from inflammation or damage within the sacroiliac joint.

• Trigger point injections. These injections involve injecting a small amount of local anesthetic, sometimes along with a steroid medication, directly into painful trigger points, specific sites on the muscles that cause pain (both locally and throughout the back) when your doctor presses on one during an exam. These injections may be helpful if you experience back pain when pressure is applied to certain areas.

Two types of implantable devices are used to treat back pain – those that deliver electrical stimulation to the spinal cord and those that deliver medication to it.

• Spinal cord stimulation. Spinal cord stimulation is believed to decrease the perception of pain by activating nerves in your lower back to block pain signals going to that area. As a result, pain is replaced with a pleasant tingling sensation. Spinal cord stimulation is delivered through a set of electrodes that are inserted between the vertebrae into the epidural space. A pulse generator or radio receiver surgically placed under the skin in the abdomen or the upper buttocks area activates the electrodes. The procedure may be appropriate for people with nerve-root injuries that haven't responded to conventional treatment and those for whom surgery has not been successful.

• Implanted drug infusion. Also called intraspinal drug infusion therapy involves implanting a pump in the body to deliver a regular, predetermined dose of narcotic pain medicine via a tube into the painful area of the spine. By targeting medication to the precise site of pain, the device enables you to use much smaller amounts of medications than would otherwise be necessary to control pain. Precise targeting of small doses also reduces the risk of side effects you might experience with higher oral doses of pain-relieving medication.